Mohd Yusran Othman1,2, Huma Faiz Halepota1,3, Yun Le Linn1, York Tien Lee1,4,5, Kenneth T E Chang4,5,6, Summaiyya Hanum Ahamed4,7, Joyce C M Lam4,5,8, Rajat Bhattacharyya4,5,8, Ah Moy Tan4,5,8, Amos H P Loh9,10,11. 1. Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. 2. Department of Pediatric Surgery, Hospital Tunku Azizah (Women's and Children's Hospital), Jalan Raja Muda Abdul Aziz, Kampung Baru, 50300, Kuala Lumpur, Malaysia. 3. Department of Pediatric General Surgery, Indus Hospital, Plot C-76, Sector 31/5, Karachi, Pakistan. 4. Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore. 5. VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. 6. Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. 7. Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. 8. Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. 9. Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. amos.loh.h.p@singhealth.com.sg. 10. Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore. amos.loh.h.p@singhealth.com.sg. 11. VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. amos.loh.h.p@singhealth.com.sg.
Abstract
PURPOSE: Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass. METHODS: We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups. RESULTS: Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery-10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p < 0.001). Three resection patients were surgically down-staged. Second surgeries were required in 30% and 40% of resected and biopsied patients, respectively, at median 4.6 months. Survival was similar in both groups, but better in patients on LMB96 protocol and stage II/III disease. CONCLUSIONS: Children with upfront attempted resection had low rates of surgical down-staging, greater delay in chemotherapy initiation, but fewer gastrointestinal complications and subsequent surgeries than biopsies. Survival was similar regardless of upfront surgery, likely reflecting beneficial effects of newer protocols.
PURPOSE: Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass. METHODS: We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups. RESULTS: Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery-10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p < 0.001). Three resection patients were surgically down-staged. Second surgeries were required in 30% and 40% of resected and biopsied patients, respectively, at median 4.6 months. Survival was similar in both groups, but better in patients on LMB96 protocol and stage II/III disease. CONCLUSIONS:Children with upfront attempted resection had low rates of surgical down-staging, greater delay in chemotherapy initiation, but fewer gastrointestinal complications and subsequent surgeries than biopsies. Survival was similar regardless of upfront surgery, likely reflecting beneficial effects of newer protocols.
Entities:
Keywords:
Gastrointestinal late effects; Non-Hodgkin lymphoma; Surgical down-staging; Treatment delay; Upfront surgery
Authors: D M Hays; J L Ternberg; T T Chen; M P Sullivan; L M Fuller; M Tefft; F Kung; G Gilchrist; C Fryer; R N Heller Journal: Surgery Date: 1984-09 Impact factor: 3.982